Health Canada loss or theft report helper
A free helper for Health Canada’s Loss or Theft Report Form (CS-FRM-011). Fill it in here, print or copy it, then file it yourself on Health Canada’s portal. Nothing you type leaves your browser.
Your deadline
Health Canada needs a written report within 10 days of finding a loss or theft. Controlled Substances Regulations s. 109(2), in force October 1, 2026: a written report to the Minister within 10 days after the day you become aware of the loss or theft. The clock runs from discovery, not from the day your investigation closes.
Pick the day you found it to see your deadline.
1. Submitter Information
Who is filing it.
2. Site Information
The pharmacy. Type of location: Pharmacy.
3. Incident Details
What happened.
Details of Discovery
4. List of Controlled Substances and/or Precursors Lost or Stolen
One row per drug.
- Row 1
5. Preventative Measure
What will change. A ticked item is added to the text.
Print or copy the draft
Still blank on the form: First Name, Last Name, Email Address, Legal Entity Name, Site Telephone Number, Municipal Address, City, Province/Territory, Postal Code, Date of Discovery, Incident Sub-Type, At least one drug.
NarcCount doesn't send it, you do: enter it on Health Canada's E-Services Portal, or fill in the official form (PDF) and email it to ocs.reporting-rapporter.bsc@hc-sc.gc.ca. Anyone can draft a report; only the “official individual” can submit it. For a pharmacy, that is a staff pharmacist or the pharmacy manager (if a pharmacist).
See the text
NarcCount fills this report in from your count. Get started
Draft · not sent to Health Canada
Prepared on narccount.ca.
Loss or Theft Report Form for Controlled Substances and Precursors (CS-FRM-011) REPORT SUMMARY Date of Submission of This Report: — Type of Report: Initial Report 1. SUBMITTER INFORMATION First Name: — Last Name: — Email Address: — Telephone Number: — Professional Title: Pharmacist Licence / Registration Number: — 2. SITE INFORMATION Legal Entity Name: — Site Name: — Type of location: Pharmacy Canada Revenue Agency Business Number: — Site Licence Number: — Telephone Number: — Municipal Address: — City: — Province/Territory: — Postal Code: — Email Address: — 3. INCIDENT DETAILS Date of Discovery: — Incident Sub-Type: — Has this incident been reported to police?: No Did the incident occur in transit?: No Are you reporting this incident as a result of a Health Canada inspection?: No DETAILS OF DISCOVERY — 4. LIST OF CONTROLLED SUBSTANCES AND/OR PRECURSORS LOST OR STOLEN — 5. PREVENTATIVE MEASURE —